Continuing Student Request for New DS-2019 - International Center

DS-2019 Request FormFor Continuing StudentsThis form is to be used for continuing U-M students only if you Have been out of the US for an extended period of time and need a new SEVIS record and DS-2019 to re-enter the US Need to regain J-1 status through reinstatement or travel Are a continuing student changing status to J-1 Are a continuing J-1 student who will be transferring back to U-M after a short absenceDo not use this form if you are a new student. Do not use this form if you are a continuing student being admitted to a newprogram at U-M. Please contact your admitting department for an DS-2019.You must meet with an International Student and Scholar Advisor (ISSA) to submit this request.LAST NAME FIRST NAME MIDDLE NAME UMID #DATE OF BIRTH (mm-dd-yyyy)GENDERNUMBER of J-2 DEPENDENTSUNIQNAME FEMALE MALETELEPHONEDELIVERY METHODSEVIS ID # PICK-UP SHIP (See “SHIPPING OPTIONS”)NComplete this section.1. Specify the term and year you plan to resume your studies and register full time. Year ______________ Fall term Winter term Spring half term Summer half term Spring–Summer term2. Specify the term and year you anticipate completing your program. Year ________________ Fall term Winter term Spring half term Summer half term Spring–Summer term3. Provide contact information for your Academic Advisor.Name _________________________________ Telephone ________________________ Uniqname ___________________4. Country of permanent residence _______________________________________5. Position/occupation in your country of permanent residence before coming to the U.S. _________________________________6. City of birth _____________________________________Important notes. Please read.If you will change status to J-1 inside the U.S., refer to instructions atwww.internationalcenter.umich.edu/immig/jvisa/j_chngstatus.htmlIf you are currently outside the U.S., or planning to exit and reenter the U.S. to gain J-1 status, please plan for additional timeto receive the DS-2019, apply for a J-1 visa, and enter the US before the begin date on the DS-2019.You may enter the US no more than 30 days before the begin date indicated on the DS-2019.After gaining J status, you must meet with an ISSA at the IC for Check-In.Before submitting this request, update your permanent (out of U.S.) and current (U.S.) addresses in Wolverine Access.Page 1 of 2m:/icall/icpdf/isss/j1/j1-student/ds02019requestform/DS2019request.pdf Rev 5/07 06/15 DP1500 Student Activities Building • 515 E. Jefferson Street • Ann Arbor MI • 48109-1316TEL: 734.764.9310 • FAX: 734.647.2181 • EMAIL: icenter@umich.edu • WEB: internationalcenter.umich.edu

DS-2019 Request FormFor Continuing StudentsChecklist of required documents. Copy of your passport page(s) showing your picture, biographical information, and its expiration date Copy of paper or print-out of electronic Form I-94 (please click on the link for instructions) if you are inside the U.S. Copy of your current DS-2019, page 1 An unofficial transcript downloaded from Wolverine Access A completed Financial Resources Statement and supporting financial documentsOptional: If you will have J-2 dependents, complete and submit the form to Add J-2 DependentsI certify I have read the request form instructions and information in full.I certify the information I have provided is, to the best of my knowledge, accurate.I understand I (and any J-2 dependents) must have U-M approved health insurance for the duration of my J-1 status.I understand I must report any address changes, current (U.S.) or permanent (out of U.S.), through Wolverine Access within10 days of the change.Signature ___________________________________________________________Date ______________________________Please do not staple forms.Page 2 of 2m:/icall/icpdf/isss/j1/j1-student/ds02019requestform/DS2019request.pdf Rev 5/07 06/15 DP1500 Student Activities Building • 515 E. Jefferson Street • Ann Arbor MI • 48109-1316TEL: 734.764.9310 • FAX: 734.647.2181 • EMAIL: icenter@umich.edu • WEB: internationalcenter.umich.edu